By Cynthia Orofo
There are two experiences I will never forget as a nurse: the first time I had to withdraw care from a patient and the first day working on a COVID ICU.
Both were unforgiving reminders that the ICU is a demanding place of work that will stress you in every way. But the latter experience was unique for a few particular reasons. Before the end of that first shift, I had overheard several staff members on the floor speak about their fears, thoughts of the unknown, and their version of the “new normal.” As I realized that life would almost certainly not be the same, I developed my own vision of the “new normal” of health care.
I remember my first day on the COVID ICU: I spent hours practicing aseptic technique, turning patients to their abdomens with a team of at least three nurses, and mentally preparing myself to be in the same room with the virus that changed the world as I knew it, all before admitting my patient.
But the mental burden was the main thing I reflected on at the end of the day. Nurses, unfortunately, are well accustomed to the ‘burnout’ phenomenon, due to the demands of the field. The stressors of the pandemic, though, have been unmatched and relentless.
Because of this, I anticipate that a post-COVID workforce will need seamless connections to mental health services. It was not until nearly a year into the pandemic that I learned of initiatives like the National Black Nurses Association’s RE:SET and the Emotional PPE that provide free mental wellness connection for frontline workers. Increased programing that integrates mental wellness support into the care of care providers is essential for us getting through, and past, the pandemic.
Addressing Disparities in Health Care and the Workforce
As a doctoral student, I have come to understand the importance of integrating the social determinants of health into health education, practice, policy, and research. Here are ways I reimagine each in the post-COVID future:
Education: Health care training programs will take a comprehensive systemic approach to education where the social determinants of health are addressed from both physiologic and psychological perspectives. Students will better understand the root of disparities, and will not allow bias to reduce race down to an oversimplified proxy for actual complex causes.
Practice: Originally thought to be the non-discriminating “great equalizer,” COVID-19 reinforced inequity-fed disparities among marginalized groups. An ideal post-COVID workforce is one where health workers check our own biases to ensure quality, equitable experiences to all groups within our role as providers and colleagues.
Policy: Policy is a powerful tool to safeguard nursing practice. Health care workers, especially nurses, should be empowered in advocating for adequate representation in health policymaking and also hold government bodies accountable for addressing issues of unfair treatment within patient care and the workforce. We see this Mayor Marty Walsh’s declaration of racism as a public health crisis last summer, as well as the recently introduced House Resolution 86, which would hold Congress responsible for finding ways to meet the needs of frontline workers.
Research: I quickly learned through my own experience that research tends to find a one-dimensional cause of health disparities, as demonstrated through recent source analysis of disproportionate COVID-19 susceptibility in the literature. But these disparities are caused by a complex interaction of multiple factors and are perpetuated by racist structures, like redlining and de facto segregation, and must inform the course of health research. Additionally, increased representation of nursing in health care research is also imperative to creating feasible solutions for evidence-based practice and supporting the entire workforce.
Shift to eHealth
In the age of rapidly growing technological advances, I have come to appreciate health care’s recognition of newly emerging platforms for service delivery and information dissemination. However, as the digital divide continues to perpetuate a longstanding access barrier, marginalized groups are continually disadvantaged when seeking digital health information. Still, eHealth or electronic health can be a reasonable solution to meet the growing demand of care, ease burden on providers, augment health care delivery across populations, and free up providers to service marginalized groups through traditional care.
Given the pandemic’s global impact, health care organizations must embrace globalization and allow for the inclusion of varying perspectives on health care. To facilitate this, starting in academia, this would call for the formation of an institution-wide international student body whose function mirrors the World Health Organization to keep matters of global health at the forefront in general training.
From nursing school, to clinical practice, to nursing research, I have recognized the growing importance of increasing diversity in health care. A diverse network of professionals in the field can collaboratively pursue universal, quality health care. This calls for academia to meet the needs of underserved students by providing resources and opportunities to equitably prepare the next generation of health professionals. This also calls for the integration and empowerment of professions underutilized in clinical care, such as community health workers, to improve health outcomes.
Working on the frontline during the pandemic has been a life-changing experience. As devastating as it has been, I am comforted by the fact that in the future, it can be an instrumental catalyst for positive change.
Cynthia Orofo is a Nigerian-American Cardiothoracic ICU nurse at Tufts Medical Center and a Northeastern University Nursing PhD student immersed in health equity research, particularly related to innovations in community health worker clinical integration.
This post is part of our digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce.